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General NPI Number Information
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NPI Number | 1780407627
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Entity Type | Individual
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Provider Name | JENNIFER RENEE WILLOUGHBY LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 115 FAIRBANKS RD
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City | OAK RIDGE
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State | TN
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Zip | 37830-7052
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Country | US
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Telephone | 865-482-6098
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Fax |
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Provider Business Mailing Address
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Address Line | 147 MCGHEE LN
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City | JACKSBORO
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State | TN
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Zip | 37757-4508
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Country | US
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Telephone | 615-636-3358
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0000014869
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License Number State | TN
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